Showing 75 of 75 entries Sort Name (A–Z) Recommendation Hold lead time Class
ACE inhibitors & ARBs Cardiovascular Hold morning of surgery when high concern for hypotension; otherwise continue (see caveats) Individualize Conditional Unverified
Acetaminophen Analgesics Continue through the perioperative period. Continue Verified
Alpha 2 agonists Cardiovascular Continue through the perioperative period. Continue Conditional Unverified
Antianxiety agents (benzodiazepines & buspirone) Psychotropic Continue through the perioperative period. Continue Unverified
Antiarrhythmics (chronic) Cardiovascular Continue through the perioperative period. Continue Verified
Anticoagulants (warfarin, DOACs) Hemostasis Not covered in this source — see linked topic. See other topic Unverified
Antidiarrheals Gastrointestinal Continue up to the day before surgery; hold on the morning of surgery. Hold Verified
Antiemetics (PRN) Gastrointestinal Continue through the perioperative period. Continue Conditional Verified
Antihistamines — first generation (sedating) Allergy & ENT Continue before the day of surgery; hold on the day of surgery. Hold Verified
Antihistamines — second generation (non-sedating) Allergy & ENT Continue through the perioperative period. Continue Conditional Verified
Antipsychotics Psychotropic Withhold in patients whose baseline or follow-up ECG shows QT prolongation; complete discontinuation may be preferable after psychiatry consultation Individualize Conditional Unverified
Antiretroviral agents Antiretroviral Continue through the perioperative period. Continue Conditional Verified
Aspirin Hemostasis Highly dependent on surgery and indication — see caveats. Can be safely continued for minor dental/dermatologic procedures. Individualize Conditional Unverified
Beta blockers Cardiovascular Continue through the perioperative period. Continue Unverified
Butalbital combinations (Fioricet/Fiorinal) Analgesics Hold on the day of surgery. Long-term or frequent users: ideally wean over 2 weeks preoperatively; if not weaned, take preoperatively to avoid withdrawal. Hold Conditional Verified
Calcium channel blockers Cardiovascular Continue through the perioperative period. Continue Unverified
Cannabis & CBD products Supplements Ideally discontinue before surgery; at minimum, avoid on the day of surgery and disclose use to anesthesia. Discontinue Conditional Verified
CGRP antagonists (migraine prophylaxis) Neurologic Continue through the perioperative period. Continue Conditional Verified
Chronic opioid therapy (incl. buprenorphine, methadone) Opioids Continue through the perioperative period. Continue Conditional Verified
Cilostazol Hemostasis Discontinue at least 2–3 days prior to elective surgery (manufacturer recommends at least 5 days) Discontinue Unverified
Digoxin Cardiovascular Continue through the perioperative period. Continue Unverified
Dipyridamole Hemostasis If discontinued: dipyridamole alone stop at least 2 days before; Aggrenox (aspirin-dipyridamole) stop 7–10 days before Individualize Conditional Unverified
Direct-acting vasodilators Cardiovascular Continue through the perioperative period. Continue Verified
Diuretics (loop & thiazide) Cardiovascular Generally hold morning of surgery; continue uninterrupted if HF fluid balance historically hard to control Individualize Conditional Unverified
Drugs used for osteoporosis/osteopenia (bisphosphonates) Endocrine Withhold only the morning of surgery for general surgery. For dental surgery, see caveats — generally do NOT hold. Individualize Conditional Unverified
Drugs used for thyroid disease Endocrine Continue through the perioperative period. Continue Unverified
Estrogen therapy in transgender women Endocrine Not covered in this source — see linked topic. See other topic Unverified
Fish oil / omega-3 fatty acids Supplements Continue through the perioperative period. Continue Verified
Gabapentinoids Neurologic Continue through the perioperative period. Continue Verified
Glaucoma eye drops Ophthalmic Continue through the perioperative period. Continue Unverified
GLP-1 receptor agonists Endocrine SPAQI 2025: continue GLP-1 RAs perioperatively (if no significant GI symptoms) with a modified fast — 24 h no solids, clear liquids until the usual cutoff. Many institutions still follow older hold guidance — confirm local anesthesia policy. Individualize Conditional Verified
Glucocorticoids — perioperative stress dosing Endocrine Not covered in this source — see linked topic. See other topic Unverified
Glucocorticoids (inhaled & systemic, pulmonary use) Pulmonary Continue through the perioperative period. Continue Unverified
Gout therapy (colchicine, allopurinol, probenecid) Gout Colchicine: hold on the morning of surgery. Allopurinol: continue. Individualize Conditional Unverified
H2 blockers & proton pump inhibitors Gastrointestinal Continue through the perioperative period. Continue Unverified
Herbal medications (general) Herbal General recommendation: stop herbal agents at least 1 week before surgery. Agent-specific timing varies — see caveats. Discontinue Conditional Unverified
Inhaled beta agonists & anticholinergics Pulmonary Continue through the perioperative period. Continue Unverified
Intranasal steroids & antihistamines Allergy & ENT Continue through the perioperative period. Continue Unverified
Laxatives, stool softeners & fiber Gastrointestinal Continue through the perioperative period. Continue Verified
Leukotriene inhibitors Pulmonary Continue through the perioperative period. Continue Unverified
Lithium Psychotropic Continue through the perioperative period. Continue Conditional Unverified
Medications affecting kidney function (general note) Renal No single timing — this is a general cautionary note, not a drug-specific recommendation Individualize Conditional Unverified
Medications for benign prostatic hypertrophy (alpha-1 antagonists) Urologic Continue through the perioperative period. Continue Conditional Unverified
Melatonin Supplements Continue through the perioperative period. Continue Verified
Monoamine oxidase inhibitors (MAOIs) Psychotropic If discontinuing: taper and discontinue 2 weeks before elective surgery (recovery of MAO function takes ~2 weeks). May be continued only if BOTH criteria in caveats are met. Individualize Conditional Unverified
Naltrexone Opioids Oral naltrexone: hold 2–3 days before surgery if perioperative opioids are expected. Extended-release injection (Vivitrol): schedule elective surgery 24–30 days after the last injection. Discontinue Conditional Verified
Neurologic agents (antiseizure, Parkinson, dementia, MS, MG) Neurologic Continue through the perioperative period. Continue Conditional Verified
Nitrates (long-acting) Cardiovascular Continue through the perioperative period. Continue Verified
Non-statin hypolipidemic agents Cardiovascular Stop the day before surgery Discontinue Unverified
NSAIDs Hemostasis Generally discontinue at least 3 days before surgery; ibuprofen can be stopped 24 hours prior. Nonacetylated NSAIDs (salsalate, diflunisal) can be continued. Discontinue Conditional Unverified
Oral contraceptives Endocrine Generally continue with thromboprophylaxis; if discontinuing for high VTE risk, stop 4 weeks prior Individualize Conditional Unverified
Oral decongestants Allergy & ENT Continue before the day of surgery; hold on the day of surgery. Hold Conditional Verified
Oral diabetic agents & insulin Endocrine Not covered in this source — see linked topic. See other topic Unverified
Other antidepressants (trazodone, mirtazapine, etc.) Psychotropic Continue through the perioperative period. Continue Verified
Overactive bladder agents Urologic Continue up to the day before surgery; hold on the morning of surgery (antimuscarinics AND mirabegron/bethanechol). Hold Verified
P2Y12 receptor blockers Hemostasis Not covered in this source — see linked topic. See other topic Unverified
PDE5 inhibitors Urologic Hold for 3 days before surgery (erectile dysfunction or BPH use). Hold Conditional Verified
Postmenopausal hormone therapy Endocrine Moderate/high VTE-risk procedures: stop at least 2 weeks prior. Low VTE-risk: continue uninterrupted. Individualize Conditional Unverified
Psychostimulants (ADHD medications) Psychotropic Withhold on the day of surgery Hold Unverified
Ranolazine Cardiovascular Continue through the perioperative period. Continue Verified
Rheological agents (pentoxifylline) Hemostasis Discontinue preoperatively, with the last dose taken the morning of surgery Discontinue Unverified
Rheumatologic agents (DMARDs, biologics, JAK inhibitors) Rheumatologic Conventional DMARDs: continue. Biologics: hold one full dosing cycle before elective surgery. JAK inhibitors: hold 3 days. Individualize Conditional Verified
Selective estrogen receptor modulators (SERMs) Endocrine Low/moderate-risk surgery: continue. High VTE-risk: raloxifene stop 3 days prior; tamoxifen (prevention) stop 2 weeks prior; tamoxifen (cancer treatment) usually continue Individualize Conditional Unverified
Selective serotonin reuptake inhibitors (SSRIs) Psychotropic Most patients: continue. High-bleeding-risk procedures (e.g., CNS) or patients needing ongoing antiplatelet therapy: consider tapering several weeks prior. Individualize Conditional Unverified
SGLT2 inhibitors Endocrine Stop 3 to 4 days before surgery Discontinue Unverified
Skeletal muscle relaxants Analgesics Baclofen and tizanidine: continue, including the day of surgery. Centrally acting agents (carisoprodol, cyclobenzaprine, metaxalone, methocarbamol, orphenadrine): hold on the day of surgery. Individualize Conditional Verified
Smoking-cessation agents Psychotropic Continue through the perioperative period. Continue Conditional Unverified
SNRIs & bupropion Psychotropic Considerations parallel SSRIs — see the SSRI entry Individualize Conditional Unverified
Statins Cardiovascular Continue through the perioperative period. Continue Unverified
Theophylline Pulmonary Discontinue the evening before surgery Discontinue Unverified
Topical dermatologics Dermatologic Continue through the perioperative period. Continue Unverified
Tricyclic & tetracyclic antidepressants Psychotropic Generally continue; if tapering is chosen (low dose / arrhythmia concern), taper off over 7–14 days before surgery Individualize Conditional Unverified
Triptans Neurologic Take as usual preoperatively; hold on the day of surgery. Hold Verified
Valproate (valproic acid) Psychotropic Continue through the perioperative period. Continue Unverified
Vitamins & minerals Supplements Commonly held 7 days preop together with other supplements for simplicity; plain vitamins/minerals are low-risk to continue. Individualize Conditional Verified